Welcome Attestation Page

All questions require a response.

Patient has already been enrolled.

What type of prescription drug insurance do you have?

Commercial prescription drug insurance through an employer-sponsored or private health plan.

Prescription insurance coverage through a state or federal healthcare program, including but not limited to Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD), Tricare or ChampVA programs.

I am not covered by prescription drug insurance.

Are you the patient or the legal guardian of the patient?

I am the patient

I am the legal guardian of the patient

Are you 18 years of age or older?

Yes

Privacy Statement

Please understand the information you provide, along with activity pertaining to your use of the Bristol-Myers Squibb Access Support Co-pay Card, may be used by Bristol-Myers Squibb or parties acting on its behalf. Bristol-Myers Squibb may use this information to contact you via mail, telephone, in electronic format or otherwise about this program and other information that it believes to be of interest to you. Please be aware that from time to time our privacy policy may change. You can read the most recent version of our privacy policy at www.BMS.com. You can stop future marketing communications and use of your information by calling 1-800-861-0048.

I confirm that I have read the program terms and conditions, including the eligibility requirements, and that the information I have provided is correct to the best of my knowledge.

HE-US-2300803 12/23

Please note: This resource is for informational purposes only. Information on this site should not be construed as medical advice. The submission and completion of reimbursement- or coverage-related documentation is the responsibility of the patient and the healthcare professional.

Welcome to the BMS Access Support Oncology Co-Pay Assistance Program

Privacy Statement